RI Suffered More Than 260 COVID Deaths in January – Why Booster Shots Are Critical
Thursday, February 03, 2022
The peak of the Omicron surge is behind us, and hospitalization rates are also in decline.
But deaths continue and infection rates are still high in Rhode Island and much of the country. Rhode Island suffered more than 260 COVID deaths in January alone. Deaths from COVID are a ‘lagging indicator’ since it takes several weeks after getting infected to die, and in the past week, deaths were up 25% nationally.
Since the beginning of the pandemic 3,334, Rhode Islanders have died of the virus.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTRhode Island’s rate of new COVID cases is about double what it was a year ago when the state was the most highly infected place on Earth.
That is fueled in part by the more contagious Omicron variant.
Vaccination will be part of our lives going forward if we want to stay healthy. Immunology and vaccine science is one of the most complicated fields in biology. Here are some critical issues that everyone needs to understand.
How the COVID vaccines work
The COVID vaccines teach our bodies to make antibodies that bind to and deactivate the virus. The Pfizer and Moderna vaccines use mRNA, which is injected and enters our cells and instructs them to make a piece of the COVID virus’s “spike protein”. Our cells then display that piece of protein on their surfaces, which triggers our immune system to both produce antibodies against it as well as activate other cells to fight the invading virus.
The Johnson & Johnson vaccine uses a different method to deliver the payload to our cells and instruct them to produce antibodies, by using a modified harmless virus.
The vaccines do not contain the actual SARS-CoV-2 virus, and cannot cause infection. The genetic material delivered by any of the vaccines is rapidly destroyed and does not become part of our DNA.
Vaccine protection needs periodic boosting
Most vaccines do not give life-long immunity, for two reasons. First, antibody levels decline over time, and second, the continued evolution of viruses creates new mutations and variants that require new vaccines to combat. Thus, with most vaccines, periodic booster shots or new vaccinations are needed to continue to provide protection.
The flu vaccine many people are familiar with provides about 6 months of protection. That, combined with new strains appearing every year means that annual flu shots are the norm for continued protection.
Most vaccines require either multiple doses to build up protection, or periodic booster shots https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. With some vaccines, effective protection can vanish in as little as 3 months https://www.science.org/content/article/how-long-do-vaccines-last-surprising-answers-may-help-protect-people-longer.
As we age, our immune systems become less robust and have diminished responses to vaccination. Immunocompromised individuals, such as those on immunosuppressive drugs for autoimmune diseases, also have diminished responses to vaccines.
As a result, the older we get the more boosts we may need.
Because antibody levels decline gradually, vaccine protection is not an ‘on-off’ switch. It’s not possible to say one is ‘protected’ one day and ‘not protected’ the next. The degree of protection declines over time, with that time period sometimes being somewhat arbitrarily set as the point at which meaningful protection is below a certain threshold for most people.
COVID remains a serious threat
The Omicron variant has shown to be somewhat less virulent than Delta, though it’s still not clear if that is because it intrinsically causes less severe illness, or because populations are more protected because of antibodies from vaccination or prior infection. However, that does not make it ‘mild’, and the enormously increased transmissibility of Omicron means that your personal chances of getting infected, hospitalized, or dead, may be higher.
The Alpha variant was about twice as virulent as the original Wuhan COVID strain, and Delta was about twice as virulent as Alpha. If Omicron is about half as virulent as Delta, that makes it about as severe as the Alpha variant that decimated the country and Rhode Island a year ago, but with much greater transmissibility and immune escape. A variant that is 50% as virulent but 500% more transmissible = 250% greater chance of illness and its consequences.
More variants are coming
The pandemic unfortunately does not end with the Omicron surge declining. With so many people infected at any one time, particularly the unvaccinated, there are plenty of reservoirs for the virus to continue to mutate and evolve. New variants are being identified roughly every two weeks. While many if not most of these should be irrelevant, we should expect future waves of problematic variants – which underscores the need to be protected by vaccination.
Even the Omicron variant may not be done with us. Two new Omicron variant sub-types has been identified, called BA.2.
What is surprising about BA.2 is the large number of additional mutations it has accumulated compared with the original Omicron BA.1 - 85 vs. 53. It would normally be expected to take much longer for the virus to accumulate so many new mutations, but it did so quickly with this variant.
In the U.K. Omicron BA.2 is doubling every 4 days, which means it has a 90-120% growth advantage over the original Omicron BA.1 strain, and in Denmark Omicron BA.2 now accounts for about 50% of cases.
The good news is that Omicron BA.2 does not appear to be any more virulent, or have any greater immune escape, than Omicron BA.1. However, its increased transmissibility may be the reason for the prolonged, slower decline of Omicron cases than had been hoped for from the rapid increase, and will draw out the recovery.
Most importantly, it’s a reminder that the virus continues to mutate and evolve, and we need to remain vigilant.
Children are getting hit particularly hard
Children have been hit especially hard in the Omicron surge, and they are not ‘immune’ from the effects of the virus.
Last week 1.15 million COVID infections were reported in children, a doubling of cases compared with two weeks ago. Over 10.6 million children have become infected since the start of the pandemic – over 14% of all children have become infected.
Rhode Island has, by far, the highest per capita rate of child COVID infections in the country with about 29% of the children in our state having been infected (the next most infected state, West Virginia, reports under 24% of children being infected). 64,026 children in Rhode Island have had COVID infection, and 369 have been hospitalized (Rhode Island does not make public the number of children who have died of COVID). Children in Rhode Island are getting infected at more than double the national average rate.
Not all states report hospitalizations and deaths in children from COVID, though from those that do, over 35,000 have been hospitalized and nearly 800 have died.
Part of the reason children are being hit so hard by Omicron is because so few are vaccinated. A recent analysis shows that only 18.8% of children aged 5-11 are fully vaccinated in this country. Rhode Island is doing much better than the national average for child vaccination with 40% of our 5-11-year-olds now fully vaccinated, but that still leaves 60% unprotected
A widely held myth is that children do not suffer from COVID infection. It is true that children generally have less severe infections than adults, but they can still experience great harm.
This past week a 15-month-old toddler died of COVID.
In another case last week a 20-year-old aspiring model had to have both of her legs amputated because COVID infection damaged her heart, impairing blood circulation and causing irreversible damage to her legs. Vaccination continues to be a primary defense against COVID, one that everyone deserves and should have - including children.
Immune escape
The COVID virus has been mutating rapidly, with several waves of variants already having attacked us – Alpha, Delta, and most recently Omicron. More significant variants may be coming,
Many of the mutations in the virus are happening in the ‘spike region’, which is both the part of the virus it uses to attach to and enter our cells, and also the region of the virus that is targeted by vaccine antibodies. The more mutations that happen in the spike region, the less tightly antibodies bind to and neutralize the virus. This is the process of ‘immune escape’. Evolutionary pressures select for mutations and variants that are less susceptible to antibodies (have greater immune escape) because this lets them reproduce and multiply more efficiently.
Immune escape is not necessarily ‘complete’. With most variants it is a degree of reduced susceptibility to antibodies. The Omicron variant has over 50 mutations, including 36 in the ‘spike’ region. This makes the Omicron variant 33 times less susceptible to antibodies from the Pfizer vaccine, and 74 times less susceptible to the Modern vaccine compared with the original COVID Wuhan strain – meaning, it would take 33 (or 74) times of a higher antibody level to neutralize the Omicron variant as well as against the original virus.
As discussed, because antibody levels decline over time, they can drop below the point of providing meaningful protection as quickly against a variant like Omicron.
Two shots of a Pfizer or Moderna vaccine cannot produce a level of antibodies that will give significant protection against the Omicron variant. A third (booster) vaccine dose can increase antibody levels to higher than those seen after initial vaccination, putting them into the range where they can give effective protection against Omicron.
What COVID vaccines do for you
Most vaccines cannot provide ‘sterilizing immunity’ which would be complete protection against having any kind of infection. What most vaccines can do is give ‘functional immunity’, which is to protect you from dying or becoming severely ill. The COVID vaccines may have provided some sterilizing immunity for a short time against the original Wuhan strain for which they were designed, but they primarily offer functional immunity: they cannot completely and always prevent you from getting infected by more virulent variants like Delta and Omicron, and they can reduce but not totally stop disease transmission. But they can keep you alive and from getting severely ill.
Adding to the confusion are the many ways ‘effectiveness’ has been measured with the COVID vaccines, including –
% protection against infection – the highest standard, measures the proportion of vaccine recipients in a study that have been protected from any symptomatic infection.
% protection against hospitalization or severe illness – an important measure, to keep people from becoming very ill, but can sometimes be complicated by how ‘severe’ illness is defined or the standards of admitting people to hospitals in different areas.
% protection against death – perhaps the most important and clearest measure, to keep people alive.
Rather than get immersed in the specific percentages, and since the % effectiveness declines over time, it’s more useful to focus on the bottom line: how much more protection is offered by being vaccinated and boosted compared to not?
The latest data from the Centers for Disease Control show that adults who are vaccinated and boosted have a 68-fold lower risk of dying of COVID, and a 13-fold lower risk of getting infected, compared to being unvaccinated.
This is the simplest and clearest way of measuring the benefit of being vaccinated and boosted, and the strongest argument for it. Being vaccinated and boosted will give you a tremendously better chance of living, and staying out of the hospital, when faced with COVID.
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